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NSIDRC Journal Article Alert – December 12, 2008
Prepared by the National Sudden and Unexpected Infant/Child Death &
Pregnancy Loss Resource Center at Georgetown University.
Past issues of NSIDRC journal alerts are available at http://www.sidscenter.org.
Availability of full-text journal articles is often limited to
subscribers or through inter-library loan. Please see your local
library for copies of these articles, or view PubMed's How to Get the
Journal Article
for more details.
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Sudden Infant Death
1. Machaalani R, Say M, Waters KA
Serotoninergic receptor 1A in the sudden infant death syndrome
brainstem medulla and associations with clinical risk factors
Acta Neuropathol. 2008 Dec 4. [Epub ahead of print]
Department of Medicine, and The Bosch Institute, University of Sydney,
Room 206, Blackburn Building, DO6, Sydney, NSW, 2006, Australia,
ritam@med.usyd.edu.au.
The immunoreactivity of the serotoninergic receptor subtype 1A
(5HT(1A)R) was quantitatively analyzed in the human infant brainstem
medulla (caudal and rostral levels). We hypothesized that
immunoreactivity of 5HT(1A)R would be reduced in infants diagnosed
with sudden infant death syndrome (SIDS). In particular that those
infants with known clinical risk factors (including cigarette smoke
exposure, bed sharing and sleep position) would have greater changes
than those without clinical risks. Comparing SIDS (n = 67) to infants
who died suddenly with another diagnosis (non-SIDS, n = 25), we found
decreased 5HT(1A)R immunoreactivity in the majority of the nuclei
studied at the rostral medulla level including dorsal motor nucleus of
the vagus (DMNV), nucleus of the solitary tract, vestibular, and
inferior olivary nucleus (ION). There was a significant relationship
with all risk factors for 5HT(1A)R, especially for DMNV, suggesting
that 5HT(1A)Rs are highly vulnerable to various insults within the
SIDS DMNV. This study not only provides further evidence of
abnormalities within the brainstem serotoninergic system of SIDS
infants, but also shows that these changes may be associated with
exposure to clinical risk factors.
Bereavement
1. Gold KJ, Schwenk TL, Johnson TR
Brief report: sedatives for mothers of stillborn infants: views from a
national survey of obstetricians
J Womens Health (Larchmt). 2008 Dec;17(10):1605-7
Department of Family Medicine, University of Michigan, Ann Arbor,
Michigan 48104-1213, USA. ktgold@umich.edu
Although no guidelines support the use of benzodiazepines in
bereavement care, clinicians continue to use this medication for
surviving family members. An anonymous survey about perinatal death
was sent to 1500 United States obstetricians. One question assessed
beliefs about prescribing sedatives to bereaved mothers. Almost half
(49%) of 804 obstetricians endorsed the use of sedatives, such as
benzodiazepines, for acute bereavement. Grieving families may
experience mental and physical anguish after a death; however,
benzodiazepines are not part of recommended care for bereavement. The
surprisingly high support from physicians for the use of sedatives in
the case of maternal grief raises important questions about how
physicians can best support bereaved mothers and what effect
benzodiazepines may have in the grieving process.
2. White DL, Walker AJ, Richards LN
Intergenerational family support following infant death
Int J Aging Hum Dev. 2008;67(3):187-208
Institute on Aging, Portland State University, Portland, OR 97207,
USA. dwhi@pdx.edu
The death of a child is a traumatic, nonnormative family life event.
Although parental bereavement has received substantial attention,
little research has focused on extended family members affected by a
child's death, and still less on how multiple family members perceive
and respond to one another following the loss. Guided by a life course
perspective, this article examines social support between grandparents
and their adult children in the aftermath of infant death. Through
structured, open-ended interviews, 21 grandparents and 19 parents from
10 families described how they provided support to and received
support from their intergenerational partners. Data were analyzed
using a grounded theory approach. Six categories of support were
identified: being present, acknowledgment, performing immediate tasks,
information, unskilled support, and no support. Most support was
provided by grandparents to adult children rather than from adult
children to grandparents. All families reported significant support
from at least one grandparent and nearly all families described
ambivalent relationships that complicated support. Gender, family
lineage, and family history were major influences. Multiple family
perspectives about a significant life event contribute to our
understanding about the intersection between individual and family
life.
Miscarriage/Stillbirth/Prenatal Issues
1. Haadsma ML, Groen H, Fidler V, Seinen LH, Broekmans FJ, Heineman MJ, Hoek
The predictive value of ovarian reserve tests for miscarriage in a
population of subfertile ovulatory women
A.Hum Reprod. 2008 Dec 4. [Epub ahead of print]
Department of Obstetrics and Gynaecology, University Medical Center
Groningen, University of Groningen, PO Box 30.001, 9700 RB Groningen,
The Netherlands.
BACKGROUND The increase in miscarriage rate with female age is
attributed to a decline in oocyte quality. This age-related decrease
of oocyte quality is accompanied by a decrease in oocyte quantity.
Assessment of the number of oocytes by ovarian reserve tests (ORTs)
may therefore also represent their quality. The objective of our study
was to assess the predictive value of ORTs for miscarriage in
subfertile women. METHODS This study was a subanalysis within a
prospective cohort study of 474 subfertile ovulatory couples in two
hospitals in Groningen, The Netherlands. The ORTs performed were:
antral follicle count (AFC), basal and stimulated levels of
follicle-stimulating hormone (FSH) and inhibin B, and the clomiphene
citrate challenge test (CCCT). Women who achieved an ongoing pregnancy
(n = 233) were compared with women experiencing miscarriage (n = 72)
on the results of their ORTs and patient characteristics. RESULTS In
univariate analysis, the outcome of the ORTs did not differ between
the groups. Logistic regression analysis including patient
characteristics such as female age did not reveal an association
between the ORT results and miscarriage either. CONCLUSIONS Neither
AFC, basal and stimulated levels of FSH and inhibin B, nor the CCCT
have a statistically significant predictive value for miscarriage in
subfertile ovulatory women.
2. Russo RC, Garcia MG, Barrientos G, Orsal AS, Viola M, Moschansky P,
Ringel F, Passi A, Alaniz L, Hajos S, Blois SM
Murine Abortion is Associated with Enhanced Hyaluronan Expression and
Abnormal Localization at the Fetomaternal Interface
Placenta. 2008 Dec 5. [Epub ahead of print]
University Medicine Berlin, Charité Centrum 12 Internal Medicine and
Dermatology, Biomedical Research Building, Campus Virchow,
Augustenburger Platz 1, 13353 Berlin, Germany; Cátedra de
Inmunología-IDEHU, Facultad de Farmacia y Bioquímica, Universidad de
Buenos Aires, UBA-CONICET, 1113 Buenos Aires, Argentina.
The remodelling of the endometrial architecture is fundamental to
create a suitable environment for the establishment of pregnancy.
During this process, substantial alterations in the composition of
maternal extracellular matrix play an important role by providing a
prosperous medium for implantation as well as modulating trophoblast
invasion leading to the formation of a functional placental unit.
Hyaluronan is a conspicuous component of the extracellular matrix,
particularly in remodelling tissues undergoing regeneration and
repair. During gestation, changes in HA deposition and distribution
indicate that this molecule may participate in preparation of the
endometrial stroma for reception and implantation of the embryo.
However, little is known about the role of hyaluronan at the
fetomaternal interface, specially regarding its influence in pregnancy
outcome. In the present study we show increased decidual hyaluronan
levels in spontaneous abortion compared with normal pregnancy mice on
gestation day 7.5. Both in normal and pathologic pregnancies, high
molecular size hyaluronan was found at the fetomaternal unit. However,
hyaluronan metabolism (which results from the activity of hyaluronan
synthases and hyaluronidases) seems to be altered in spontaneous
abortion as shown by a decrease in Hyal-3 expression as well as by
differences in hyaluronan molecular size spectrum. This alteration in
hyaluronan metabolism in spontaneous abortion could explain its
increased concentration observed in decidua and the abnormal
distribution of hyaluronan around the embryo implantation crypt. Thus,
increased decidual hyaluronan levels resulting from abnormal
deposition and turn over may contribute to the pathogenesis of
pregnancy failure.
3. Fujimura Y, Matsumoto M, Kokame K, Isonishi A, Soejima K, Akiyama
N, Tomiyama J, Natori K, Kuranishi Y, Imamura Y, Inoue N, Higasa S,
Seike M, Kozuka T, Hara M, Wada H, Murata M, Ikeda Y, Miyata T, George
JN
Pregnancy-induced thrombocytopenia and TTP, and the risk of fetal
death, in Upshaw-Schulman syndrome: a series of 15 pregnancies in 9
genotyped patients
Br J Haematol. 2008 Nov 26. [Epub ahead of print]
Department of Blood Transfusion Medicine, Nara Medical University,
Kashihara, Nara, Japan.
Summary Upshaw-Schulman syndrome (USS) is a congenital thrombotic
thrombocytopenic purpura (TTP) due to mutations in the gene that
encodes for ADAMTS13 (ADAMTS13), but its clinical signs may be mild or
absent during childhood. We have identified 37 patients with USS (24
females, 13 males) belonging to 32 families. The nine women from six
families who were diagnosed during their first pregnancy are the focus
of this report. Six of the nine women had episodes of thrombocytopenia
during childhood misdiagnosed as idiopathic thrombocytopenic purpura.
Thrombocytopenia occurred during the second-third trimesters in each
of their 15 pregnancies, with 16 babies (one twin pregnancy), often
followed by TTP. Of 15 pregnancies, eight babies were stillborn or
died soon after birth, and the remaining seven were all premature
except one, who was born naturally following plasma infusions to the
mother that had started at 8 weeks' gestation. All nine USS women had
severely deficient ADAMTS13 activity. ADAMTS13 analyses demonstrated
that eight women were compound heterozygotes of Y304C/G525D (2
siblings), R125VfsX6/Q1302X (2 siblings), R193W/R349C (2 siblings),
I178T/Q929X, and R193W/A606P; one woman was homozygous for R193W. Only
the R193W mutation has been previously reported. These observations
emphasize the importance of measuring ADAMTS13 activity in the
evaluation of thrombocytopenia during childhood and pregnancy.
4. Bottomley C, Daemen A, Mukri F, Papageorghiou AT, Kirk E, Pexsters
A, De Moor B, Timmerman D, Bourne T
Assessing first trimester growth: the influence of ethnic background
and maternal age
Hum Reprod. 2008 Dec 2. [Epub ahead of print]
Early Pregnancy and Gynaecological Ultrasound Unit, Department of
Obstetrics and Gynaecology, St George's, University of London, Third
Floor, Lanesborough Wing, Cranmer Terrace, London SW17 0RE, UK.
BACKGROUND First trimester growth restriction may predict miscarriage
or adverse outcome later in the pregnancy, but determinants of early
growth are not well described. Our objective was to examine factors
influencing fetal and gestational sac size in the first trimester.
METHODS Prospective observational study of 1828 singleton pregnancies
before 12 weeks gestation. Maternal characteristics (ethnicity,
maternal age, obstetric history, abdominal pain and vaginal bleeding),
crown rump length (CRL) and mean gestational sac diameter (MSD) were
recorded. A stepwise linear mixed effects analysis was performed to
determine factors influencing rate of change in CRL and MSD. RESULTS
1063 scans, in 464 women, were included. Rate of increase in CRL was
higher in women of black ethnic origin (P = 0.0261) compared with
white, and increased with advancing maternal age (P = 0.0046).
Maternal age also influenced MSD: older women had gestational sacs
which were 0.118 mm larger for each one year increase in maternal age
(P = 0.0073). Bleeding, pain and prior obstetric history did not
influence CRL or MSD. CONCLUSIONS Rate of increase in CRL was greater
in fetuses of black versus white women and increased with advancing
maternal age. As CRL is used to date pregnancies, and this influences
further growth assessment, consideration should be given to the use of
individualized growth charts which take account of maternal factors
found to influence first trimester growth.
3:40 AM
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